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Summer schedule: 9AM Sunday School, 10AM refreshments, and church fellowship meals take a break in July & August. Please join us for Worship Service, which is still held every Sunday at 10:30 AM!
Calvary Community Church

Sunday School

Lesson 4: Biblical Counseling and Psychotropic Drugs

Speaker
David Capoccia

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In this fourth lesson, Pastor Dave Capoccia considers what the truths from the previous lessons about the Bible’s sufficiency and the mind-body connection mean for the issue of psychotropic drugs. Pastor Dave overviews the topic of psychotropic drugs from a biblical perspective and then considers a few frequently asked questions.

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Note: This transcript and summary was autogenerated. It has not yet been proofread or edited by a human.

Summary

This lesson examines the topic of psychotropic drugs from a biblical perspective, asking whether mind-altering medications are an appropriate solution for what the world calls “mental illness.” We are reminded that the Bible describes the symptoms associated with mental disorders—such as depression, anxiety, and behavioral problems—as spiritual issues rooted in the heart, not primarily biological conditions requiring chemical treatment.

Key Lessons:

  1. Labels shape how we think about solutions—using biblical language like “soul enslavement” rather than “mental illness” helps us see problems and solutions more clearly.
  2. The chemical imbalance theory behind psychotropic drugs has never been proven, and even many medical professionals admit they do not know exactly how these drugs work.
  3. Psychotropic drugs appear to suppress the mind rather than restore balance, functioning more like chemical handcuffs than true treatments—and they bury the real spiritual causes of problems.
  4. Physical contributors to spiritual struggles should be investigated and treated, but when the Bible identifies something as a spiritual issue, we should not settle for unproven physical solutions.

Application: We are called to use biblical labels when describing people’s struggles, to ask good questions before offering counsel, to point people to Christ’s sufficiency rather than relying on unproven chemical treatments, and to help struggling brothers and sisters with compassion while directing them to the deeper, lasting solutions found in God’s Word.

Discussion Questions:

  1. How does the label we use for a problem—”mental illness” versus “soul enslavement”—shape the way we approach helping someone?
  2. If a fellow believer is on psychotropic drugs and asks for your counsel, how would you balance compassion with biblical conviction?
  3. How does Paul’s response to his thorn in the flesh (2 Corinthians 12:7-10) challenge our tendency to be obsessed with finding a cure rather than glorifying God in our affliction?

Scripture Focus: Proverbs 18:13 (listen before answering), Philippians 4:13 (enduring all things through Christ), 2 Corinthians 12:7-10 (God’s grace is sufficient in weakness), 1 Corinthians 10:13 (no temptation uncommon to man), Ecclesiastes (insanity in the hearts of men), and James 1:19-21 (be quick to hear and receive the word with humility).

Outline

Introduction

All right, well good morning. Welcome to Sunday school. Let’s begin with a word of prayer.

Heavenly Father, thank you for this time as we address this serious topic today. I pray that this would be an edifying time. Give me words to explain well and help us to take seriously what is spoken and to compare it to your word and live accordingly. In Jesus’ name, amen.

Now, in our fourth lesson of the Biblical Counseling 101 Sunday school class, “Why do I do what I do and how can I change,” I want to go right into our time today by reviewing the homework. Remember, you do have homework for this class. I hope you’re doing that. That’s how you actually get the most out of this course.

I’m only a guide here. I’m introducing many topics to you in the class, but you really learn it and get it reinforced in the homework. Hopefully you’re continuing that extremely important habit of reading the Bible and praying every day.

Homework Review: A Biblical View of Illness

I’m not going to go over the extra credit assignment. I hope you found that edifying, especially the more thorough explanation of the placebo effect and also the importance of double blind studies versus just anecdotal, subjective experiences. But let’s talk about the other article—the regular homework that I asked you to read: “A Biblical View of Illness.”

I asked you to write down five observations or questions. What are some things that stuck out to you or that you had questions about from reading that article?

Let me start with one clarification. If you found it a little bit confusing at the very beginning when he said some illness is due to sin and other illness is due to personal sin, that may be a little bit confusing. But when he says it’s due to sin, he means just the fall—the effect of the cursed world. He’s not saying you actually did something and that’s the reason why you’re sick. That’s more when he’s talking about personal sin, okay?

“When he says illness is due to sin, he means the fall—the effect of the cursed world.”

What other things did you notice or have questions about? Yeah, Mark, that’s right.

Mark mentioned the author’s point about Job and how illness actually reveals our character and even moves us towards sanctification. It’s interesting too where he makes the point about Paul with his affliction. It may have been an illness, but it was actually to prevent him from sin, to keep him from exalting himself. He said the thorn in the flesh. We’ll mention that verse again in just a moment.

Illness as an Avenue for Glorifying God

What else? Yeah, Glendon, that’s right. That’s a really important point to make. I hope that’s one of the main takeaways you got from this article: that illness actually can be spiritually strengthening, and it can be a special avenue for glorifying God.

If you’ve been part of our Zoom prayer meetings, that’s one of the things that I’ve also tried to remind our church about when we pray for those who are sick in our church. Don’t just pray that they get healed. That is something we want to pray, but more important than that is that a person will be able to be strong in the Lord and glorify Him through that illness.

In fact, for some people, their greatest testimony for the Lord happens when they are very sick, maybe even terminally ill. That is when they have unlocked for them a special time of ministry. We need to embrace that, and we need to help one another embrace that with compassion, with sympathy, with grieving along with the other person, but directing them: “This is not an accident from God. This is now a special time of your ministry.”

“For some people, their greatest testimony for the Lord happens when they are very sick, maybe even terminally ill.”

Other questions or comments? Yeah, April, right? Yeah, April, that’s a good point. Just pointing out how the author purposefully uses a different term than “psychosomatic.” He calls it “physiological-spiritual” or “spiritual-physiological.” I forget exactly the order, because that helps us remember that there is a component of how we react to our circumstances. We are responsible for it, which is sobering but also encouraging.

Now, it’s kind of amazing. I presented this to you last time, but it’s kind of amazing and also maybe a little bit troubling that a lot of the affliction—even physical affliction—that we and others experience is actually caused by our own minds. That’s not to say that every time somebody feels physical symptoms of illness and they can’t figure out the cause, that you say, “Oh, you have a spiritual problem. You must have some sin in your life.” We might be making the same mistake as Job’s friends.

It could be something that they just haven’t discovered yet. But if they have physical symptoms, or if we have physical symptoms, and there’s a clear spiritual problem in a person’s life, you can say, “Oh, I think there might be a connection. You’re so anxious, or you’re so angry, or you’re so depressed, and they can’t find a medical cause for what you’re going through. There could be a connection here. There’s likely a connection here.”

Next Week’s Homework

Well, I hope you were benefited from that article, and that you’ll also benefit from the new articles. Let’s talk about next week’s homework. I actually want to keep you in the Christian Counselor’s Medical Desk Reference with two articles very connected to what we’re going to talk about today.

The first is your regular assignment besides Bible reading and prayer, and remember, that’s important. It doesn’t matter to me so much how much you do, but just do it. Be consistent and focus: Bible reading and prayer with God.

I also want you to read Chapter Five from the Christian Counselor’s Medical Desk Reference: “Are Psychotropic Drugs Needed in Counseling and Biblical Counseling?” Make five observations and questions on that.

For extra credit—this will be sent to you in the email if you’re signed up as part of the class. I do have a few paper copies, but there’s another article: “Attention Deficit Hyperactivity Disorder.” The author takes time to view that from a biblical counselor’s perspective.

“It doesn’t matter to me so much how much you do, but just do it. Be consistent.”

Any questions about the homework? Okay.

Scenario: Counseling a Depressed Person

Now, before we get into the main part of our lesson, I want to address something that we didn’t get to at the end of the last lesson: a review and application of some of the things we were talking about in Lesson Three, the mind-body connection. I want to do this with a set of theoretical scenarios.

Suppose a Christian brother or Christian sister—if that would be more appropriate and you’re female—comes to you and tells you that he is depressed. He says he feels very little joy in life, very little motivation to go on each day. How would you respond to this person? What’s the first thing you might say to him or do with him?

Herb suggests asking how you can help. That’s a good question to ask. Catherine suggests asking how long he’s been feeling that way or she’s been feeling that way. Both of these responses are good because the very first thing we should do is ask more questions and get more data.

Ask Questions Before Giving Answers

Don’t just be like, “Well, let me tell you what the Bible says about depression and hopelessness.” You need to find out more information because that’s going to allow you to give a more skillful and helpful answer.

I’ve mentioned this verse before, I think in this class, but certainly in other venues. Proverbs 18:13 says, “He who gives an answer before he hears it is folly and shame to him.” You want to go to the Bible right away. That’s a good impulse, but you need to ask more questions. You need to find out more information. You need to gather data. This is critical in counseling.

Proverbs 18:13: “He who gives an answer before he hears it is folly and shame to him.”

Someone tells you that he’s depressed. Find out more about what’s going on in his life and even what’s going on with his health. I told you that depression—that kind of more modern term—biblically we could describe that same experience as sad hopelessness or sad dissatisfaction. That is ultimately an inner man issue, and you want to probe that and address that in that person’s life.

Physical Contributors to Spiritual Struggles

But you are aware, especially from last lesson, that there are outer man issues—issues of the physical body—that can contribute to the feeling or experience of depression or hopelessness. Knowing this, what kind of questions could you ask about a person’s physical well-being?

“There are outer man issues—issues of the physical body—that can contribute to the experience of depression.”

Mark, that’s a good question to ask: “Tell me about your sleep. How much sleep do you usually get? When do you go to sleep?” What else?

“Tell me about your diet and maybe some things related to how and whether you eat.” Family relationships aren’t so much physical, but they certainly will impact a person’s life and can contribute and reveal the cause of hopelessness.

April, what about more health-related questions? That’s a very good and extremely important question: “Are you taking any medications? Have you recently started a medication or changed medications?” That can actually be very impactful.

We could just ask generally, “How is your health?” We could ask: “How is your sleep? How often do you exercise? Have you recently started or changed medications? When’s the last time you visited a doctor, and what was the report?”

Now, depending on how well the person knows you, they may not be ready to give you all that information. But if they’re really looking for help from you, those are some good things to find out.

We Are Not Doctors

Now, I wanted to say this last time. I didn’t get a chance, but let me remind you: I don’t think there are any exceptions in here. Well, maybe a little bit. We are not doctors. Even though we know certain things about the mind-body connection, we should definitely refrain from diagnosing physical illnesses.

“Your doctor said this. I think this is what’s going on. I think you have this disease.” We’re not doctors. But we can work with doctors to spot and treat physical conditions that contribute to spiritual problems.

If you suspect that physical factors could be affecting your counseling spirit, one of the best things you could do is recommend they go to a doctor and get a thorough physical exam. That can rule out some physical contributors to whatever spiritual issue they might be going through.

“We can work with doctors to spot and treat physical conditions that contribute to spiritual problems.”

Changes in physical areas will not eliminate a spiritual problem, but they can help. Let me give you a quick story about this: Pastor Bill Shannon was the pastor of the fellowship group that we were part of in California when we were at Grace Community Church. He was also the one who oversees their counseling department.

He told a story about a woman in his congregation who was a faithful, God-loving woman following after Christ. All of a sudden, one day she said, “I am just so depressed, and I can’t figure out why. I am just so sad all the time.” Her husband couldn’t figure it out, and nobody could understand why.

But Pastor Bill started asking some questions related to her physical health. One of the questions he asked was, “Did you recently change medications?” She said yes.

When he dug into it a little bit more, he found that one of the common side effects of this medication was depression. He mentioned that to her. She spoke to her doctor about it, and the doctor changed the medication. That feeling of hopelessness and dissatisfaction went away.

So it’s important that we ask about physical contributors to some spiritual issues.

Scenario: Hypothyroidism and Medication

Now, this guy—this theoretical man or woman who comes to you talking about depression. Let’s say you go through some of these questions. You go through this process. The guy visited his doctor. The doctor gives him a blood test, and he’s diagnosed as a result with hypothyroidism.

Hypothyroidism is a known physical disorder in which the thyroid gland does not produce enough of a hormone associated with the body’s metabolism. This lack of hormone certainly has an effect on a person physically. But one of the inner man characteristics of people with hypothyroidism is depression. They often have an increased feeling of sadness or hopelessness.

A doctor, if someone is showing behavioral or physical symptoms of hypothyroidism, might order a blood test to see whether there are certain levels in the blood that would confirm a hypothyroidism diagnosis.

Let’s say this fellow is diagnosed with hypothyroidism. The doctor prescribes medication. There is no once-and-for-all cure for hypothyroidism, but it can be treated. If you take ongoing medication, it makes up for the lack of hormones and allows you to recover from the difficult symptoms—even the feelings of sadness and hopelessness.

“God gave us medicine. It benefits us if we use it when it treats a physical problem.”

Knowing all this, the man asks you, “Should I follow my doctor’s treatment plan?” What would you say?

That’s a good idea. There’s no reason not to. This is a known physical disorder. The cause is physical. The medicine treats the physical problem. Why not? God gave us medicine. It benefits us if we use it when it treats a physical problem.

When a Cure Is Unavailable

Now, let’s throw in this monkey wrench. Let’s say that due to COVID and global supply chain problems, the man cannot obtain the medicine to treat his physical condition. There’s a backup. It’s not available. He’s simply stuck with this hypothyroidism. He knows he has it, but he can’t do anything about it.

What counsel would you give the man in this condition?

Yeah, Glenda? Okay, okay. So just practically, “How can I help you? Am I able to obtain the medication for you?” But let’s say there’s no way. There’s none in the United States. There’s no way to obtain the medication. What can we say?

Yeah, Jane? Okay, so Jane’s suggesting maybe look into other solutions, maybe a homeopathic, maybe there are other ways that can help treat the condition. Magnet, what are you going to say?

Yeah, okay. So Magnet, to mention that: encourage this person not to be focused on himself but to actually think about how can I glorify God in the midst of this and even minister to others.

Now, from the homework reading, I think one of the points that Dr. Smith made that was really good is that we have to beware of becoming obsessed with a cure. If you are able to find a cure, that is good stewardship of your body before God. But that’s not the reason why you’re alive. You’re here to glorify God.

“We have to beware of becoming obsessed with a cure. That’s not the reason why you’re alive. You’re here to glorify God.”

And if you get totally distracted with finding a cure, it will drain your finances, drain your energy, and totally remove your ability to glorify God. If you’re able to get better, do it. But if not, don’t worry too much about it.

The Lord’s Sufficiency in Ongoing Affliction

You say, “Oh, but I have this hypothyroidism. It makes me feel increased depression.” Well, what did people do before there was even a discovery of hypothyroidism or a cure for hypothyroidism? Were the Christians who had that just left in the lurch? No. The Lord was sufficient for them.

It was harder physically. It was harder for them to rejoice in the Lord, to be content, to be focused on ministry. But the Lord was still sufficient. And this is something that we need to remind our counselees who may have an issue that cannot be treated—even something that affects or has an influence on the inner man.

“The Lord was sufficient for them. It was harder physically, but the Lord was still sufficient.”

What’s interesting to me: I started listening to a little bit of Jeremiah Burroughs, “The Rare Jewel of Christian Contentment.” He’s a Puritan from the 1600s. At one point in the book, he mentions that when it comes to contentment, some people just have a more melancholy disposition, which is kind of an interesting statement.

It’s almost like, without knowing about hypothyroidism, he was mentioning that there could be something physical like that—that some Christians just have it. It is more difficult for them in a certain sense.

And yet the Lord is still sufficient. You can still be content. You can still walk with the Lord faithfully, even if you have a condition like that.

So we want to sympathize and show compassion to somebody who has a condition that cannot be treated. But we also want to direct him to his supreme, compassionate, sympathetic, sufficient Lord and the Lord’s word.

Scenario: Terminal Illness

Kind of along the same lines, let’s say an alternate scenario: the depressed man comes to you. As you talk with him, he reveals that he was recently diagnosed with a painful and rare form of cancer, and there is no cure. What counsel should you give the man in that physical situation? It’s a similar situation, right?

Grieve with him. People accuse biblical counsel of just throwing the Bible at people. We don’t want to do that. Grieve with him. Say, “I am so sorry. This is the world that we live in. God didn’t make it like this, and one day it won’t be like this. But it is the way it is now, and I’m so sorry. I’m so sorry to hear that this is the case with you.”

Even be willing to cry with that person. Show compassion. Scripture says, “Grieve with those who grieve.” But then give him hope. Give him hope in the kingdom that is to come. Assure him that he can rely on and glorify the Lord even in a terminal illness.

“Grieve with him. Show compassion. But then give him hope in the kingdom that is to come.”

And like we said at the beginning, it’s actually a special opportunity for ministry. Remember, this is Paul’s attitude. Philippians 4:13: “I can do all things through Christ who strengthens me.” That is, “I can endure all things.” Brother, sister, you can. We can together.

Paul’s Thorn in the Flesh

And as Paul also says about his thorn in the flesh, I want to actually read that passage to you. Second Corinthians 12:7-10. Again, we don’t know what the thorn in the flesh was. It could have been physical. It could have been something circumstantial.

But Paul says about it in Second Corinthians 12:7-10:

“Because of the surpassing greatness of the revelations, for this reason, to keep me from exalting myself, there was given me a thorn in the flesh, a messenger of Satan to torment me, to keep me from exalting myself. Concerning this, I implored the Lord three times that it might leave me. And He has said to me, ‘My grace is sufficient for you. My power is perfected in weakness.’”

What was Paul’s response to that? “Man, God is unkind. Man, God doesn’t care about me?” No. He said, “Most gladly therefore I will rather boast about my weaknesses so that the power of Christ may dwell in me. Therefore, I am well content with weaknesses, with insults, with distresses, with persecutions and difficulties for Christ’s sake. For when I am weak, then I am strong.”

2 Corinthians 12:9: “My grace is sufficient for you. My power is perfected in weakness.”

Our moment of severe affliction is a time of great weakness. But if we look at the example of Paul, that’s actually a time where we can be spiritually strong and a great witness for the Lord.

We can have joy in the Lord even in our times of greatest trial.

Scenario: Anxiety Without Medical Cause

Now, one more scenario with this man. You’re asking questions. As you talk with this man, you find out he is indeed suffering physically. He reports extreme muscle tightness, painful bowels, headaches. But he goes to a doctor, and the doctor cannot find anything medically wrong with him.

As you get to know the man, you can see that he is racked with anxiety. He’s extremely worried about his life. The doctor notices this too and suggests, “You see a psychologist, and then a psychiatrist to deal with the anxiety.”

The man asks you whether he should. What would you tell him?

That’s one of the main questions of our course, right? Is the Bible sufficient? Is the Lord sufficient? Is this an inner man problem? If it is, then the Lord should be sufficient, shouldn’t he?

Dr. Smith in his article poses the same question, right? The same situation. And the conclusion that he comes to at the end is: “Why would you send him to someone who can only offer an inferior solution? You have something much more effective. You have something superior.”

Tell this man that Christ and the Bible are sufficient. That the world has inferior answers. And that you would like to help him. “Let me walk with you. Disciple you. Train you in the word of God so that you can respond to the temptation of anxiety rightly. And there, foresee the blessing—even the physical blessing—of trusting the Lord in your life.”

“Why would you send him to someone who can only offer an inferior solution? You have something superior.”

Psychologist vs. Psychiatrist

Now, I’m going to say more about that. I mentioned a psychologist and psychiatrist. What is the difference? Anyone tell me?

Mark, you were going to say? Yeah, one is a medical doctor, which one? The psychiatrist. That’s right. They have more medical training. They’re actually MDs. And functionally, what is different about what they do?

Yeah, Jay? Yeah, who does the medication? The psychiatrist gives medication. A psychologist gives counsel and therapy.

“The psychiatrist is an MD who gives medication. A psychologist gives counsel and therapy.”

Defining Psychotropic Drugs

Now, what kind of medicine do psychiatrists usually give? Psychotropic drugs. What are psychotropic drugs?

Well, I’ll give you a definition here as I describe it. Psychotropic drugs are literally soul-turning. “Psycho” from “psyche,” the Greek word for soul. “Tropos” means turn or change. So these are soul-turning, or maybe an easier way to describe it in modern terms: mind-altering medications. Also known as psychiatric or psychoactive drugs.

When I use the term “psychotropic drugs” today, I am referring to legal medications that are prescribed to treat what are called mental illnesses or mental disorders. These medications would include antidepressants, antipsychotics, anxiolytics, hypnotics, mood stabilizers, and stimulants.

They’re prescribed for disorders such as clinical depression, anxiety disorders, bipolar disorder, and attention deficit hyperactivity disorder.

Psychotropic drugs are the main topic of our class today. The question we want to know the answer to is: What role, if any, should psychotropic drugs play in the Christian life and in biblical counseling?

“Psychotropic drugs are literally soul-turning: mind-altering medications prescribed to treat what are called mental illnesses.”

Hopefully you’ve been through our previous lessons so that some of the things I say aren’t as startling to you as they might otherwise be. We’ve talked about the Bible’s sufficiency. We’ve talked about what biblical counseling is. We’ve talked about the mind-body connection. You need to remember all that.

Qualifications Before Diving In

But I recognize that this is probably going to be the most controversial class that we do in this course. I want to start with a few qualifications.

Number one: I recognize that this topic hits close to home for many of you. You or someone close to you may have taken or is currently taking psychotropic drugs. Your experience with these drugs may be good, bad, or more or less neutral. Know that I’m not discounting your experience—whatever it was or is—by what I say today.

But I ask you to remember that no experience is self-validating or self-interpreting. Every experience—the significance of every experience—must be determined and analyzed by an objective truth source. The only safe truth source for evaluating all of life and our experiences is the word of God.

As we consider this topic today, I ask you to remember again the counsel of James 1:19-21: “Be quick to hear, slow to speak, slow to become angry, and receive with humility the implanted word. Be a Berean. Compare what we say today to what the Bible says.”

James 1:19-21: “Be quick to hear, slow to speak, slow to become angry, and receive with humility the implanted word.”

Number two: I recognize that there are genuine brothers and sisters in the Lord who take slightly different or majorly different stances towards psychotropic drugs than what I’m going to present to you. Our disagreement in this topic is probably not so great that I could not fellowship with that person anymore. They’re still dear brothers and sisters in the Lord.

If you, after today’s course, are not convinced—”I think Pastor Dave’s totally wrong about this”—well, I still want to fellowship with you. I don’t think this is something that breaks fellowship. But I do need to talk to you about it because I do think that a wrong approach to psychotropic drugs will really hurt the church and will hurt many people individually. So we need to address it.

Number three: I am not a doctor. I am not a psychiatrist. But I can tell you this: if you are on psychotropic drugs and you decide you want to stop taking them, do not—I repeat—do not go off of them suddenly and without the guidance of a doctor. It is well known that psychotropic drugs create powerful withdrawal symptoms that can move someone to act in bizarre and even dangerous ways.

Do not be reckless. Do not be foolish. Be wise. If you’re persuaded that you don’t need psychotropic drugs, gradually wean yourself off with a doctor’s help.

With those qualifications, here’s our agenda for today. We’re going to overview the topic of psychotropic drugs from a biblical perspective, deal with a few frequently asked questions, and then hopefully, if we have time in the end, take some questions because I know this might generate some questions.

Let’s dive in.

What Is Mental Illness?

I’ve already given you a definition of psychotropic drugs. They are mind-altering chemical medications commonly used to treat mental illnesses. What are called mental illnesses? What exactly is a mental illness? What is a mental disorder? Those are synonyms.

Here’s a recent definition from the APA, the American Psychological Association. Mental disorder, or mental illness, is any condition characterized by cognitive—that is, thinking—and emotional disturbances, abnormal behaviors, impaired functioning, or any combination of these. Such disorders cannot be accounted for solely by environmental circumstances—that is, by the things happening in your life—and may involve physiological, genetic, chemical, social, and other factors.

Now, there’s some technical language there. The definition might be a little hard to understand. But we can paraphrase it this way: If you characteristically think, feel, or act abnormally or have impaired ability to act and function in your life, you have a condition constituting mental illness.

“If you characteristically think, feel, or act abnormally, you have a condition constituting mental illness.”

And from where does mental illness come? Note that the APA’s definition gives a variety of factors: environment, physiology, genetics, chemicals, social situation, and more that is not described. But if you look at what is mentioned, how many of those are physical? Of the five, three of them, right? Physiological, genetic, chemical.

But one key term in this definition—in the second part—the word “may.” What does “may” indicate? They’re not sure. They don’t know for certain.

Now, I told you before that the Bible doesn’t use the term “mental illness,” but it does describe the same phenomenon using different language. So how might we define mental illness using the Bible?

A Biblical Definition of Mental Illness

Let me give you my working definition. I say “working” because I reserve the right to refine this. But I do think, even though this may sound radical, especially based on what we just heard, I think it is fair and I think it is biblically accurate.

Here’s my attempt to define mental illness biblically: A mental illness is a condition in which wrong—that is, false, foolish, or sinful—thoughts, beliefs, and desires in the heart have become so habitual that a person’s life has become dominated by self-destructive behavior and effects.

I’ll read that again: A mental illness is a condition in which wrong—that is, false, foolish, or sinful—thoughts, beliefs, and desires in the heart have become so habitual that a person’s life has become dominated by self-destructive behavior and effects.

“A mental illness is a condition in which wrong thoughts, beliefs, and desires have become so habitual that life is dominated by self-destructive behavior.”

In this view, biblical synonyms to mental illness—if we were to use an alternate term—would be something like soul enslavement, heart ensnarement, or spiritual bondage.

Consider biblically speaking: all sin and unbelief and false thinking is a form of mental illness. Remember, Ecclesiastes says, “Insanity is in their hearts all their days,” right? Speaking of the people of the world. When you are pursuing sin and acting foolishly, in a sense you’re acting insane.

But usually, either by God’s grace or by other intervening factors, our insanity is somewhat small and local. When we get into the habit of thinking, desiring, and believing foolishly, when that becomes unrestrained, it begins to have more and more destructive effect on our lives.

When it becomes really noticeable, the world would call that person mentally ill. But biblically, that’s a person who’s just ensnared and enslaved in his inner man.

Comparing the APA and Biblical Definitions

Now, let’s compare these two definitions.

According to the APA’s definition, who’s responsible for mental illness? Nobody. It’s all these factors which are beyond your control. So nobody’s responsible for mental illness.

According to a biblical definition, who’s responsible? You. Whoever is suffering with it.

According to the APA’s definition, what is the main source of mental illness? Our environment is one. What are we gonna say, Glenda?

You mentioned medication. That would be part of the proposed treatment. But in terms of identifying primary causes, remember three out of five are considered physical, at least in their list. So a primary, if not the main, cause of mental illness according to the APA is your body—physical factors.

“According to the APA, the main cause is physical factors. According to the Bible, the source is the heart.”

According to my proposed definition, what is the source of mental illness? Not the body, but the heart. The inner man. The soul.

According to the APA’s definition, what is the implied solution to mental illness? Medication, along with counseling and therapy.

But according to a biblical definition, what is the implied solution? Heart change. Repentance, which is produced by Christ’s word and the Spirit.

Labels Suggest Solutions

Now, I’m going to support my biblical definition a little bit more as we go through the class today. But take a moment to notice something. Just in comparing these two, notice the importance of the labels you use to describe people and behavior.

Notice how the term “mental illness” or “mental disorder” already suggests that the problem is physical, that the mentally ill person is a victim, and that the solution is medical. But if you use a different term like “soul enslavement,” that suggests that the problem is spiritual, that the enslaved person is a self-victimizer, and that the solution is spiritual.

So this is a key point to remember for all of Christian living and counseling. I wrote it there on your handout: “Labels suggest solutions. Therefore, use biblical labels as much as possible.”

“Labels suggest solutions. Therefore, use biblical labels as much as possible.”

Be careful about using terms like “mental illness,” “emotional health,” or “bipolar disorder.” Even though these are common jargon of the world, these terms can obscure the true nature of these realities. Use biblical language and biblical labels as much as possible when describing these types of things.

Steve’s making a good point. That’s so important that we start with the Bible because the Bible actually describes what is compared to the world. Even the APA uses the term “abnormal.” But what is abnormal?

This is something that Ed Welsh brought out in his article too. He says to psychiatry students or psychologists, “You guys want conversions, but you haven’t agreed what you want to convert people to.”

If you look at the history of mental disorders, things that were mental disorders at one time no longer are. For example, if you thought that you were a boy when you were a girl, that was considered a mental disorder in the past. But increasingly, that’s not considered a mental disorder. It does always change.

That’s why you’re so right, Steve. We need to start and stick with the word of God and even use biblical labels.

Now, if you find my biblical definition startling—even as an example of blaming the victim—I think you’ll come to understand more why I take this viewpoint when we overview how and why psychotropic drugs are administered.

Psychotropic Drugs Overview

This is point one on your handout: “Psychotropic Drugs Overview.”

As you can see, fundamental to the issue of psychotropic drugs is whether the issue is biological or spiritual. Today, many people talk about issues such as depression or bipolar disorder like they are biological issues.

One would expect then, if a mood disorder is biological, that a mood disorder diagnosis would include the presentation of some kind of tangible, verifiable biological evidence from the body. After all, this is normal in medicine. This is normal for other health diagnoses, for problems in the body.

You have a broken bone? Here’s an X-ray that shows it. I’m not lying to you. You can see it. You have high blood pressure? Here are the numbers that back it up. You have hypothyroidism? Here’s a blood test that shows the elevated chemicals in your body.

“If it is biological, one would expect some tangible, verifiable biological evidence. This is normal in medicine.”

How Mental Disorders Are Diagnosed

However, for those of you who might know, how do doctors diagnose someone with a mental disorder?

Yeah, Mark. Mental disorders are diagnosed on the basis of observed and reported symptoms. Some of them are physical symptoms, some of them behavioral. There is no medical test to diagnose a mental disorder.

A doctor might look at a blood test to rule out physical diseases and physical disorders. But there is no test for a disease in the mind. Instead, doctors just look for a common set of behavioral symptoms. They diagnose you on that basis and then they prescribe you psychotropic drugs and/or therapy.

“Mental disorders are diagnosed on the basis of observed and reported symptoms. There is no medical test.”

For example, for an ADHD diagnosis, the American Psychological Association has determined that a doctor simply needs to confirm six of 18 symptoms over the course of six months. The possible symptoms include: “Often does not seem to listen when spoken to directly. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, such as school work or homework. Often has difficulty awaiting turn. Often blurts out answers before questions have been completed.”

That’s just a sample, by the way.

How would the Bible diagnose a child with those behavioral symptoms? Go ahead and raise your hand.

Yeah, Jay. He’s acting foolishly. April, that’s some rebellion. This is evidence of laziness, carelessness, sinful self-centeredness, and a simple lack of self-control. The Bible speaks to these symptoms.

And what does the Bible prescribe as a solution? All right, go ahead, Tina. Often in the home, it’s discipline. The rod of correction. It’s training. It’s accountability. It’s discipline that drives out and deals with that foolishness and self-centeredness.

But according to the APA, these symptoms are indicators of the mental condition ADHD. What is the proposed solution for ADHD? Medication. Ritalin or something like that.

A similar situation exists for other mood disorders. Diagnosis and treatment are given on the basis of reported symptoms and behaviors, not tangible medical evidence.

The Chemical Imbalance Theory

Now, you’re probably wondering, “Well, how can medical professionals justify such an approach?” The main theory that undergirds the use of psychotropic drugs is called the biogenic theory of mood disorders, also known as the chemical imbalance theory.

It has been postulated that the reason you are depressed, or the reason you have great mood swings, or the reason your child is hyper or distracted, is because a certain chemical is being suppressed within the brain. It’s low. Perhaps it’s serotonin or perhaps epinephrine.

The drugs seek to alter brain chemistry to restore the normal amount of the chemical. This is a nice theory. But the theory has never been proven, despite many attempts to do so. Actually, it is unprovable.

Our medical technology is not sophisticated enough to peer that closely into the brain and the synaptic connections to observe whether things are being suppressed or not. In truth, no hard evidence has ever been given to demonstrate a causal connection between chemical levels in the brain and so-called mood disorders.

There may be some correlation, but no demonstrated causal connection.

“The chemical imbalance theory has never been proven. There may be correlation, but no demonstrated causal connection.”

And today, many doctors and scientists will admit that they do not know what causes mental disorders—depression, ADD, bipolar disorder. They will even admit that they do not know how the drugs are helpful as treatments. Isn’t that kind of unnerving?

Doctors Admit Uncertainty

For example, here’s what the Mayo Clinic says about the cause of depression. This is from their website: “It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as biological differences, brain chemistry, hormones, and inherited traits.”

Or here’s what Britain’s National Health Service website says about antidepressants: “It’s not known exactly how antidepressants work. It’s thought they work by increasing levels of chemicals in the brain called neurotransmitters. Certain neurotransmitters, such as serotonin and nor-adrenaline, are linked to mood and emotion.

Neurotransmitters may also affect pain signals sent by nerves, which may explain why some antidepressants can help relieve long-term pain. While antidepressants can treat the symptoms of depression, they do not always address its causes. This is why they’re usually used in combination with therapy to treat more severe depression or other mental health conditions.”

“It’s not known exactly what causes depression. It’s not known exactly how antidepressants work.”

Actually, increasingly, doctors and psychiatrists today have criticized the chemical imbalance theory as misleading and insufficient. You can find various articles and statements about this online. For the sake of time, I won’t read all the ones I have here. I’ll just give you one from the Psychiatric Times, a 2019 article entitled “Debunking the Two Chemical Imbalance Myths.”

It says: “Ironically, anti-psychiatry groups are quite right in heaping scorn on the chemical imbalance theory of mental illness. But not for the reasons they usually give. Some people think it’s all a conspiracy by psychiatrists, but that’s not the reason. However, they are right about certain things. Scientifically speaking, there never was a network of validated hypotheses capable of sustaining a full-blown global chemical imbalance theory of mental illness.

Furthermore, the SSRIs—that is, selective serotonin reuptake inhibitors—the main type of antidepressant—were accorded rockstar status as effective antidepressants that they did not deserve. Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the chemical imbalance trope through direct-to-consumer advertising. There was no concerted attempt by our profession—psychiatrists—to promote a causal or etiological theory of mental illness in general based solely on chemical imbalances.”

Increasingly, what medical professionals will say is that physiology is a factor, but it’s complicated. There’s much more to it. It’s not simply a chemical imbalance.

Why Doctors Still Prescribe the Drugs

You’re probably wondering, based on that, if such is the case—if doctors are not sure about the causes of so-called mental illnesses and they’re not even sure how psychotropic drugs treat those causes—then why do doctors still prescribe the drugs?

Well, they do know that brain chemicals are involved. But again, correlation is not causation. Just because they’re connected doesn’t mean that one causes the other.

But what is the main answer? If they don’t really know what’s going on, why do they still prescribe the drugs?

Yeah, Glenda. Money is certainly involved. Though I think we should refrain from saying, “Oh, they’re all just in it for the money.” Some of them do have good motives.

Yeah, Judy. Certainly, it’s just general practice. If somebody comes in and their kid’s acting up, put them on ADHD medication. All right, put them on Ritalin.

Yeah, Herb? Okay, it could come down to ego. Many times, I think you’re getting some periphery factors here. But what’s really at the center of this—why they prescribe these drugs—is because they work.

They work. For antidepressants, many people do report that the drugs make them feel better. And for Ritalin, people do report that their child is less hyper once they’re on the drug.

“Why do they still prescribe the drugs? Because they work. Many people report that the drugs make them feel better.”

The basis for psychotropic drugs, then, is totally pragmatic. There’s no tangible medical proof. But psychotropic drugs seem to make people feel better and restrain unwanted behaviors. So these results are treated as evidence that the problem really is biological and not spiritual.

Pragmatism Is Not Proof

But let’s probe this conclusion a little bit. Can you think of any other situation in which people use drugs to make themselves feel better?

Yeah, coffee. Okay, yeah, Jay. Alcohol, narcotics, pain relievers. This is not a new thing. Is improved mood then proof of a restored chemical imbalance in the brain? No. Chemical balance, I meant.

Can you think of another situation where drugs successfully prevent unwanted or dangerous behavior in people or animals? Can you think of any other examples of that?

Exactly. You tranquilize wild animals with drugs. You can restrain behavior through sedatives. You can restrain behavior through general anesthesia. This is what they do when somebody gets intubated, right? They have to put them on sedatives. If they’re moving around, they would mess up their procedures.

You can use drugs to do that. So is restrained behavior proof of restored chemical balance? It’s not.

“Is improved mood proof of restored chemical balance? Is restrained behavior proof of restored chemical balance? It’s not.”

So there really is no proof that psychotropic drugs are restoring chemical balance or that the issue is truly or mainly biological.

What Are the Drugs Actually Doing?

What are these drugs doing? As I said, no one really knows for sure. They keep getting prescribed. If I may offer an opinion—this is not the authoritative word of God. This is just based on my admittedly limited observation and experience—but in my opinion, the drugs appear to work fundamentally to inhibit or suppress the mind.

They suppress the mind. And I say this because if you observe people who are on many psychotropic drugs, it’s like they’re not really there, not fully there. Sometimes they look catatonic.

Also, some people I’ve spoken to on psychotropic drugs confess they just can’t think. They feel like they’re in a fog.

How might suppressed thinking improve mood? Can’t think about your problems, right? Can’t focus on it. That might make you feel better.

Or how might suppressed thinking restrain unwanted behavior? You don’t have the mental energy and cognition to act. You’ve been sedated.

Psychotropic drugs, then, appear to function more like chemical handcuffs, mental pain relievers, or mental tranquilizers rather than restorative treatments. That’s why they have their effect. At least, that’s what makes sense to me.

“Psychotropic drugs appear to function more like chemical handcuffs or mental tranquilizers rather than restorative treatments.”

Shock Therapy Parallel

There’s an interesting parallel in another kind of more extreme psychiatric treatment designed to treat mental disorders: electroconvulsive or shock therapy. In shock therapy, a patient is put under general anesthesia and receives controlled electric shocks through the brain and endures mild seizures. These shocks and seizures alter the chemical composition of the brain, and people often report improved mood.

One of the side effects of shock therapy is amnesia. Often, people report temporary memory loss of the time of treatment and even of the weeks and months leading up to it. You can imagine: if you can’t remember your problems, you’ll probably feel better.

“One side effect of shock therapy is amnesia. If you can’t remember your problems, you’ll probably feel better.”

Now, people in the world might consider a suppressed mind an acceptable trade-off for the results of psychotropic drugs. “Hey, I feel better now. I can get on with life. Hey, my kid’s acting better now. I don’t need to concern myself with them anymore.”

Why Christians Should Reject This Approach

But why should such a solution be considered unacceptable for Christians? Let me offer an answer.

Christians fundamentally love people. Therefore, we’re not interested in merely making people feel better or even causing them to act better. We care about people’s souls. We want to get to the heart of their problems and not merely treat symptoms.

According to the Bible, what’s at the heart of these problems—whether a person is manifesting anger, hopelessness, anxiety, careless hyperactivity, or reckless self-confidence—it’s a soul caught up in wrong thinking, beliefs, and desires. A soul that is destroying itself in this life. And apart from reconciliation with Christ by repentance, it will be eternally destroyed and punished by God in the world to come.

“Christians fundamentally love people. We want to get to the heart of their problems and not merely treat symptoms.”

The world, through psychology and psychiatry, does offer help to people and their problems. But it’s limited. The help is only surface help. And it cannot, by its very nature, minister to people’s deepest and most important needs—the needs of the inner man, the needs of the spirit.

The Greatest Problem with Psychotropic Drugs

Now, there are other problems with psychotropic drugs. In some cases, the drugs are ineffective and actually make the problems worse, not better. The drugs have many side effects, many of them not fully understood. And the drugs must be taken long-term, even for the rest of your life.

One of the sad things about ADHD is that it’s likely you’ll never graduate. Many adults who started on the drug must continue with it or take something similar. But the greatest problem with psychotropic drugs is that they bury the true spiritual cause of problems.

“The greatest problem with psychotropic drugs is that they bury the true spiritual cause of problems.”

As Christians, we should not settle for psychotropic drugs as a true solution.

Our time is going fast. I’m going to have to speed through this next part and the next couple of parts. Some of this will repeat what we concluded at the end of the last lesson about the mind-body connection.

Christians do want to acknowledge, allow, and seek biological solutions when the issue can be demonstrated to be biological. Christians should acknowledge that biological factors can impact—though not determine—the disposition of the inner man.

But since there is no proof that so-called medical disorders are biological in origin, and the Bible describes their symptoms—like anger and depression—as sins and spiritual issues, Christians are not to reject the chemical imbalance theory and the accompanying system of necessary drug treatments. Instead, we should minister the deeper, sanctifying, and liberating word of God to people, especially in the church.

I don’t think I’ll have any time for questions today. But I will mention at least a few of the frequently asked questions. Sorry if you didn’t get all the notes. Maybe we can come back to that afterwards.

FAQ: Might Christians Be Repeating Past Mistakes?

In the past, people treated certain physical problems as spiritual problems because no one was fully aware of the physical situation. Might Christians be doing the same today by avoiding the use of psychotropic drugs?

We as Christians ought to be totally fine with physical treatment when a physical cause can be demonstrated. But we should take great pause when someone asserts a possible physical cause for something the Bible identifies as spiritually caused. This is the situation with psychotropic drugs.

If we went by this reasoning and said, “Well, possibly in the future they might discover some physical cause,” based on that reasoning, we can never counsel with the Bible again. You say, “Oh, you never know. Christ and the Bible are sufficient in the meantime.” It’s like with hypothyroidism. Somebody can’t get treatment for that. The Lord is still sufficient, even though it will be a little bit more difficult.

Reaching for an unproven solution to an unproven cause is just foolish. That’s poor stewardship, especially when these so-called solutions bring their own problems.

“Reaching for an unproven solution to an unproven cause is foolish, especially when these solutions bring their own problems.”

FAQ: Can the Bible Address Extreme Behavior?

Another question: Some behavior just seems so extreme. Can the Bible really explain these issues as being of the spirit?

I admit that what some people do and say can be pretty bizarre and alarming. And again, if you demonstrate a physical problem in the brain, I’m all for treating it. But we need to realize just how powerfully the inner man can exert an influence on one’s body and life.

Remember that so-called extreme behavior is just an unrestrained version of what we all experience. First Corinthians 10:13 says that there’s nothing that we encounter that is not common to man.

You say, “But look at these mass murderers. Look at these people who commit suicide. There’s something wrong with them. They have a mental disorder.” It’s just another version of what we all have, just taken to an extreme.

Jesus says what’s the same as murder? Anger in the heart, angry words. If allowed to fester and become more unrestrained, it will manifest. It can manifest in the insanity of murder. Same thing with sadness. We all experience sadness and discouragement. But when not dealt with biblically, when allowed to become more and more unrestrained, it can lead to debilitating depression and even suicide.

1 Corinthians 10:13: “There is no temptation that is not common to man. Extreme behavior is just an unrestrained version of what we all experience.”

Think about people who are delusional—they’re just believing in an alternate reality. There must be something wrong with them physically. Well, again, that’s a version of what we all experience. We can believe things that are not true because we want to or because we fear something.

You ever seen somebody who had a crush on someone else who clearly didn’t like that person back? It’s like, “Oh, I can’t wait. We’re gonna date. We’re gonna get married.” It’s a delusion. But maybe not as serious as some that are termed mental disorders. It’s just a more extreme version of that same common-to-man problem, not dealt with biblically, allowed to become more and more unrestrained. The person begins to listen to his own wishful thinking or fearful thinking rather than what the word of God says and what good counsel says.

By the way, if you are interested in a very encouraging resource on how the Bible is able to minister even to these so-called extreme cases, there’s a book called “Counseling the Hard Cases.” It’s a collection of writings. I think we might have a copy, maybe not. It deals with some really crazy situations—what we would think of as crazy situations. Then you see how the Bible was sufficient to address it.

It’s not so much a manual of how to deal with these extreme cases as a testimony of how the Bible is sufficient for soul problems.

FAQ: Is the Use of Psychotropic Drugs Ever Permissible?

I’m going to squeak by here and do these last two. Even if not necessary: Is the use of psychotropic drugs ever beneficial or permissible?

Well, some do take the approach that the drugs can help temporarily to calm the seas so that biblical counseling can actually take place. “We need to restrain this person a little bit so I can actually talk to him.” I understand that approach. But I don’t agree with it.

It’s not so easy to go on and off drugs. Side effects can be pretty severe. And they do have some unknowns. Besides, if drugs really function to suppress the mind—which is the way they appear to function—that’s the exact opposite of what you need to counsel someone. You need to talk to their mind. It’s harder for them to listen to you when they’re on the drugs.

“If drugs suppress the mind, that’s the exact opposite of what you need to counsel someone. You need to talk to their mind.”

Now, what if you say, “Okay, I’m gonna counsel this person. They’re not on the drugs, but they’re still acting in bizarre and dangerous ways. What do you do?”

Well, my biblical counseling teacher, Dr. Street, and Robert Smith, as you’ll read in the homework, they both say the same thing, which is: “Be real with your counseling. Say, ‘Look, I don’t think the drugs are necessary for you.

I do believe that, based on everything you share with me, the problem really is spiritual. But if you’re not willing to listen, if you’re going to continue to act in these alarming ways, and what you’re telling me is I prefer the secular treatment—I prefer the drugs—and if that’s what you insist, then that’s what we’ll do. That’s what you can do.

I don’t think you need that. I don’t think it’s ultimately going to help you. But if you’re not willing to listen, then what you’re saying is I prefer the secular treatment.’

It’s sad, but sometimes it’s just what you have to let people do.

Now, let me say this also: It is still possible to counsel someone on psychotropic drugs. It may take a little longer. But don’t feel like, “Oh no, there’s no way I can talk to him now.” No, you can. You still can.

Ideally, someone that you are counseling who is taking the drugs will realize, after a while, that they don’t need them when they see that Christ is supreme, sufficient, and satisfying instead.

FAQ: Should You Pressure a Counselee About Meds?

And finally: As a biblical counselor, should you ever pressure a counselee to go on or off psychotropic meds?

No. That is not your role. You can inform about the true nature of the drugs and what you believe is the counselee’s true spiritual problem. And you can definitely advise for someone not to do something suddenly because they’ll have withdrawal symptoms. Be ready to help a person if he makes the decision to stop using psychotropic drugs.

But it is much better if they make a decision about the drugs on their own. You avoid dangerous situations both physically and legally if you let them come to the conclusion. And that tends to make the person more committed to his choice.

It is not helpful when somebody keeps going back and forth between taking the drugs and not taking the drugs and taking the drugs and not taking the drugs. But sometimes they’ll do that when someone else is pressuring them to do it. They’re not convinced, but they’ll go along with it for a little while until they have a bad experience.

If they decide this on their own, they’re more likely to stick to their conviction. So it’s better to let them do it.

“It is much better if they make a decision about the drugs on their own. That tends to make the person more committed.”

Always, if they’re considering going off psychotropic drugs, they need to do it with the help of a doctor. It is not something to do all of a sudden or just on your own.

I know that may have generated a bunch of questions. I’m available to talk afterwards. There’s much more we could say on this weighty topic. That’s why I’ve given you the homework. Please read those articles.

We’ve dealt with one of the common approaches to dealing with soul problems when it comes to psychotropic drugs. Next time, we’ll talk about another common approach—the other side of it: psychological counseling.

Closing Prayer

Let’s pray.

Lord, thank you for your word. I pray, Lord, that your people will compare what they’ve heard today to what your word says. Lord, bless your people as they trust in your sufficient word. And help those, Lord, that we know who are really struggling in their souls.

They have become more and more unrestrained in their thinking, and it’s really hurt their lives. Lord, I pray that you be merciful to them and help us, Lord, to minister well your word and your Spirit to such people. In Jesus’ name, amen.

Thank you, everyone.

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